NNEMS

Question 1

NMES (Definition)

Answer 1

Neuromuscular Electrical Stimulation
Application of an electrical current to result in a tetanic contraction (a smooth transition from relaxation to contraction)
Muscle must be innervated for cary-over to occur
Will release endorphins similar to TENS
Sometimes referred to as ESTIM

Question 2

Clinical Application to Strengthen or Prevent Tissue Atrophy

Answer 2

Beneficial if you need to isolate a muscle: if a particular muscle is not working adequately (i.e. trace muscle strength)

Question 3

Strengthening: Estim vs. Therapeutic Exercises

Answer 3

Same theory: isometric 6sec hols to strengthen: 10 rep 1-3 sets: NOT ANY LONGER
Best if use activate motion with estim

Question 4

Clinical Application to Increase AROM (2)

Answer 4

1) Orthopedic settings: assist w/ pull through in occurrence of tendon adhesion: not painful pt. is not strong enough to pull through w/ on strength.
2) Inhibition of spacticity or muscle spasms: stimulate antagonist of an high tone muscle to induce/reduce tone (i.e. fisted hand after stroke or head injury: could stim to open for hygiene)

Question 5

Clinical Application for Muscle Re-education

Answer 5

Gives sensory feedback and helps motor learning: tendon transfers, muscle imbalance

Question 6

Clinical Application for Orthotic Substitution

Answer 6

FES (functional e. stim): Shoulder subluxation, ambulation

Question 7

Clinical Application for Edema Control

Answer 7

By-product of any active muscle contraction

Question 8

Denervated Muscles & NEMS

Answer 8

This is a grey area: different theories that contradict themselves:
On dennervated muscles you could be preventing muscle deterioration/atrophy
If the nerve is regenerating you may over stimulate and slow/stop nerve growth.

Question 9

Duty Cycle Parameters

Answer 9

Requires at lease a 1:2 ratio of on to off time
Some research suggests a 1:5may prevent fatigue and is better for strengthening
Ramp up time (rise time): the time it takes for the current to reach the full rate.
Ramp downs (fall time): the time it takes for the current to return to rest.
(2 sec up, 6 second isometric hold, 2 sec down= 10 sec)
10 seconds on = 20 off, 15 seconds on = 30 off
It pt. fatigues -> increase off time.

Question 10

This is measured as the current in pulses per second (pps)

Answer 10

Rate (frequency)

Question 11

Rate that allows for stimulation only

Answer 11

25pps

Question 12

Rate that allows for contraction of small muscles

Answer 12

35pps (most commonly used for OT)

Question 13

Rate that allows for contraction of larger muscles

Answer 13

50pps

Question 14

This is the type of wave form that results in a more comfortable response as the two wave phases cancel each other out and there is no over loading current.

Answer 14

Symmetrical (chosen 1st)

Question 15

This wave form is less comfortable and creates a build-up of current in the muscle.

Answer 15

Asymmetrical (Used when you are unable to elicit a contraction from symmetrical)
It creates the greatest nerve excitation under the negative electrode.

Question 16

This relates to the number of separate currents you have occurring during a tx. and when they occur.

Answer 16

Cycling (alternating or synchronous)

Question 17

Cycle that is used at a time when you want to have both leads working at the same time

Answer 17

Synchronous (used to stim larger muscle groups)

Question 18

Cycle used when you want the electrodes to alternate

Answer 18

Alternating (used on practical) - Can alternate between flexor and extensors, also used when you are using only one lead to one group of muscles (our purposes)

Question 19

This is the length of the individual wave form

Answer 19

Pulse width.

For UE musculature we always set this at 300 miliseconds as this is the most comfortable and effective.

Question 20

Tx. time for NEMS

Answer 20

Generally you want the client to perform 10-12 reps.

You may repeate up to 3 x with a several minute break in between. (x20-10min)

Question 21

2 Characteristics of electrode size and placement

Answer 21

1) Use two electrodes (ore multiples of two): one over the motor point.
2) Size is based on maximizing muscle coverage while minimizing overflow into other muscles.

Question 22

Negative vs. Positive

Answer 22

If symmetrical waveform: no need to pay attention to polarity
If asymmetrical waveform: recommended negative at motor point (limited evidence for this)

Question 23

Bipolar polarity

Answer 23

Use the same size electrode over muscle parallel to fiber at each end of the muscle belly for most comfort.

Question 24

Monopolar Polarity

Answer 24

Use smaller electrode over motor point you want to isolate and a larger electrode elsewhere as a dispersive electrode (i.e. palmaris longus transportion to thumb)
Used to get a stronger and more specific response but may be less comfortable
This will increase the current density to the motor point so it may need less amplitude

Question 25

6 “other things” to know about NEMS

Answer 25

1) Rate and duty cycle will affect the quality and strength of the muscle contraction and rate of fatigue.
2) Amplitude will affect comfort level and determine the magnitude of the sensory motor response
3) Fatigue will occur and stop if it does
4) If biting sensation or burning sensations occur: replace the electrode
5) Make sure there is full contact w/ the skin
6) If using for home check understanding, compliance, and tolerance

Question 26

NEMS Precautions and contraindications

Answer 26

Follows standard electrical modality precautions and remember: anytime active exercise is contraindicated, NEMS is contraindicated